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PubMed1975

Cardiac contusion: a capricious syndrome.

Cardiac contusions are being recognized with frequency. Among 507 patients with non-penetrating chest injuries, 210 had serial electrocardiograms sufficient to evaluate the heart. Forty-five of these 210 patients (21%) had cardiac contusions. These 45 patients and 3 others who were confirmed to have cardiac contusions at necropsy, comprise the 48 patients in this series. Life-indangering cardiac complications occurred in 14 (29%) of the 48 patients, and 4 patients died. The development of cardiac complications following cardiac contusions appears to have a significant relationship to the presence of shock, hypoxia and to factors related to the severity of multiple injuries. These observations have therapeutic implications in management of patients with cardiac contusions through prevention of hypovolemia and hypoxia and avoidance of fluid overload as well as treatment of specific cardiac complications.

Accidents, Traffic↗
PubMed1990

Suspected myocardial contusion. Triage and indications for monitoring.

Although many different tests are used to diagnose myocardial contusion, the clinical implications of the diagnosis are unclear. This makes it difficult to decide which patients require admission to a monitored bed. During 16 months, 3010 patients with blunt trauma were reviewed for evidence of sequelae attributable to myocardial contusion. None of 2204 admissions to unmonitored beds had evidence of serious arrhythmias or heart failure. No patient who died after admission had myocardial contusion at autopsy. Of the 644 admissions to monitored beds, 95 had workups for suspected contusion. Heart failure not obvious on admission did not occur and there were only four arrhythmias that required treatment. Conduction abnormalities on admission electrocardiogram predicted serious arrhythmias. Echocardiography and creatine phosphokinase isoenzyme levels, although frequently positive, did not predict morbidity. Clinically significant myocardial contusions are rare. Patients who will develop life-threatening complications from blunt cardiac injury can be identified in an emergency room setting.

Adolescent↗
PubMed1986

Emergency surgery in patients with post-traumatic myocardial contusion.

Little information concerning the prognostic and functional significance of post-traumatic myocardial contusion appears to exist. During a 10-month period, 19 patients with major blunt thoracic trauma were diagnosed as having myocardial contusion using clinical findings, serial ECG and CPK-MB isoenzyme determinations, and biventricular radionuclide angiocardiography (RA). All patients had associated thoracic and extrathoracic injuries. ECG and RA were useful and complementary tests, detecting abnormalities in 90% and 47% of patients, respectively. Only one patient had an abnormally elevated CPK-MB. All patients required operative treatment for associated injuries, 15 (79%) on the day of admission. Eleven patients required perioperative cardiac inotropic support and one needed IABP. No late complications were attributable to the cardiac contusions per se; no patients died. Emergency surgery for associated injuries in patients with myocardial contusion can be safely performed using hemodynamic monitoring to guide cardiac inotropic support measures. Myocardial contusion does not constitute an absolute contraindication to necessary operations in polytraumatized patients.

Adolescent↗
PubMed1999

Prostanoids: early mediators in the secondary injury that develops after unilateral pulmonary contusion.

BACKGROUND: We have previously shown a sequence of events after unilateral pulmonary contusion that suggests the release of blood-borne prostanoid mediators and that culminates in refractory bilateral pulmonary failure. PURPOSE: To determine the role of platelet-derived thromboxane and endothelial-derived prostacyclin in the primary and secondary injury after unilateral blunt chest trauma, and to determine whether pretreatment with the cyclooxygenase inhibitor indomethacin alters the progression of secondary injury. METHODS: Anesthetized, ventilated (FIO2 = 0.50) pigs received a unilateral, blunt injury to the right thorax (n = 20) or sham injury (n = 5) and were monitored for 24 hours. Either indomethacin (5 mg/kg i.v.; n = 10) or its saline vehicle (n = 10) were administered 15 minutes before injury. Serial bronchoalveolar lavages of each lung were analyzed for protein and neutrophil (polymorphonuclear neutrophil (PMN)) content. RESULTS: Contusion caused profound hypoxemia; PaO2 partially recovered within 1 hour of injury to 50% of baseline. Thereafter, worsening hypoxemia required positive end-expiratory pressure. With indomethacin compared with vehicle, PaO2 was higher at any given level of positive end-expiratory pressure (p < 0.05). There was an early increase in serial bronchoalveolar lavage protein on the injured side (peak at 2 hours), with a delayed pulmonary capillary leak on the contralateral side (peak at 6 hours), which correlated with increasing PMN infiltration; this was reduced by 40 to 60% with indomethacin (p < 0.05). Thromboxane peaked within 1 hour after contusion at 800% baseline, then fell off rapidly. This peak preceded the maximal increase in permeability and was completely blocked by indomethacin. Prostacyclin slowly rose to 300% baseline by 3 hours and remained elevated; this change was blocked by indomethacin for 18 hours. CONCLUSIONS: Contusion of the right thorax induced a delayed pulmonary capillary leak in the left lung, which reflects a progressive secondary inflammatory response. Elevations in thromboxane and prostacyclin preceded progressive bilateral PMN infiltration. Indomethacin blocked thromboxane and prostacyclin and attenuated, but did not prevent, the progression to pulmonary failure. Overall, these data suggest that prostanoids are released soon after unilateral contusion and initiate an inflammatory response in both lungs that is sustained by PMN infiltration.

6-Ketoprostaglandin F1 alpha↗
PubMed2000

Failure of voluntary activation of the quadriceps femoris muscle after patellar contusion.

STUDY DESIGN: Descriptive study of phenomenon. OBJECTIVES: To determine the extent of failure of voluntary activation of the quadriceps femoris muscle in patients early after patellar contusion. BACKGROUND: Pain and effusion are related to the presence of quadriceps inhibition. We hypothesized that patients with patellar contusions would be unable to fully recruit their quadriceps muscles and that the activation deficit would be associated with self-report measures of function. METHODS AND MEASURES: Sixteen patients who had sustained a unilateral patellar contusion fewer than 4 months prior to testing participated in the study (7 men, 9 women; mean age = 30.0 +/- 11.6). Subjects completed a self-report questionnaire to assess knee function and performed an isometric burst superimposition test on the involved and uninvolved quadriceps at 60 degrees of knee flexion. The subjects were assigned to 2 groups according to the presence (n = 5) or absence (n = 11) of quadriceps inhibition. RESULTS: Sixty-nine percent of the subjects tested were able to fully activate their quadriceps. Both groups had a decreased knee extensor force on the involved side compared to the uninvolved, but the group with inhibition had a lower side-to-side percentage of knee extensor force (mean = 65.5% +/- 18.9) than those without inhibition (mean = 85.5% +/- 16.4). CONCLUSION: Early after patellar contusion, approximately one-third of the patients demonstrated quadriceps inhibition. According to our working hypothesis, the majority of the patients tested should have demonstrated inhibition. Quadriceps inhibition was not associated with the activities of daily living, sports activity, or global rating scales in this study. Decreased volitional quadriceps force production (the hallmark of inhibition) was the only variable that discriminated patients with patellar contusion who had inhibition from those who did not.

Adult↗
PubMed2002

Functional recovery after complete contusion injury to the spinal cord and transplantation of human neuroteratocarcinoma neurons in rats.

OBJECT: Human neuroteratocarcinoma (hNT)-derived neurons are differentiated postmitotic neurons derived from a human teratocarcinoma cell line following treatment with retinoic acid. In preclinical transplantation studies investigators have demonstrated both their safety as a source of neurons for transplantation and efficacy in treating stroke-related behavioral deficits. The objective of this study was to examine whether hNT neurons transplanted in an area of complete spinal cord contusion would improve electrophysiological measures of spinal cord function. METHODS: Complete spinal cord contusion injury, defined as the complete loss of motor evoked potentials (MEPs), was produced in 30 rats at T-8. Ten rats with contused spinal cords underwent transplantation with hNT neurons within the site of contusion immediately after injury (immediate transplant group). Ten rats underwent hNT neuron transplantation following a 2-week evaluation for loss of MEPs (delayed transplant group). Ten other rats with contusion injury served as a spinal cord injury control group, and 10 rats underwent only a T-8 laminectomy and served as non-injured controls. All rats survived 8 weeks after transplantation. In the delayed transplant group significant functional recovery was observed, as demonstrated by return of MEPs and a modest improvement of motor function. Immunohistochemical analysis showed the survival, integration, and long fiber outgrowth of the grafted hNT neurons. CONCLUSIONS: These findings suggest that the transplantation of the hNT neurons may be an effective means of reestablishing electrical connectivity of the injured spinal cord.

Animals↗
PubMed2002

[Diagnosis of heart contusions].

PURPOSE OF THE STUDY: Heart contusion is a severe injury for the diagnosis of which there still doesn't exist a uniform procedure. The aim of the work was to compare individual methods and provide opinion on the justification of their use. MATERIAL: In the period of 1998-2000 at the authors' departments 103 patient were hospitalised with a severe contusion of the chest. These patients were admitted at the department within 24 hours after the injury. METHODS: The diagnosis was based on the examination of the ratio of CKMB/CK serum levels, cTnl serum level, ECG examination and echocardiography. RESULTS: Heart contusion was diagnosed in 18 patients of the group of 103. The most precise diagnostic method proved to be the determination of the serum level of troponin I (success rate 86%) and echocardiographic examination (succes rate 67%). CONCLUSIONS: Examination of cTnl serum level and echocardiography are the best methods for the determination of the diagnosis of heart contusion. Simultaneous application of these two methods is the most reliable diagnostic procedure. Examination of CK and CKMB serum levels produces often falsely positive results and it is not a contribution to the determination of the diagnosis of heat contusion.

Contusions↗
PubMedDate not supplied

Pulmonary contusion: CT vs plain radiograms.

In experimentally induced pulmonary contusions, CT (n = 27) and chest X-ray (n = 24) findings were compared with the findings at autopsy. Twenty-seven of 27 (100%) pulmonary contusions were visible by CT immediately after trauma compared with 9 of 24 (37.5%) in the chest X-ray. After 30 min follow-up, 18 of 24 (75%) lesions were seen on the plain film. Five of 24 (21%) contusions escaped detection on conventional radiographs. Computed tomography underestimated lesion size in 5 of 60 (8%) measurements, conventional radiographs in 21 of 36 (58%) measurements. Pathological examination never revealed a pulmonary contusion that was not demonstrated by CT. Therefore, pulmonary contusion seems unlikely in a trauma patient with normal pulmonary CT.

Animals↗
PubMed1978

Computed tomography in child abuse and cerebral contusion.

Cerebral contusion is considered to be the lesion leading to neurological sequelae of mental retardation and cerebral palsy in abused children. This has been difficult to document other than at autopsy or craniotomy by previously available techniques. Acute contusion or hemorrhage presumably secondary to contusion is readily documented by computed tomography (CT). We are reporting the cases of four children with alleged or suspected abuse and CT evidence of cerebral contusion. The contusion has been found both with and without external evidence of head injury.

Brain Injuries↗
PubMed1981

[Experimental animal studies on lung contusion].

Isolating lung contusions were represented by means of animal experiments in rats. The mechanism of the trauma was a bounce against the thorax wall with a steel cylinder. Macroscopic pulmonary alterations, lung weights, the frequency of secondary injuries as well as the mortality rate are the parameters of the lesion. The lung alterations shows communities with human lung contusions. The model is suitable for the specification of histological and morphological alterations and for the pathogenesis of lung contusions as well as for the quest of diagnostic parameters. The intensity of the lung contusion is limited by initial rupture of vessels. To the test of clinical therapy and for the release of limited lung contusions there are required models with other mechanisms of trauma.

Animals↗
PubMed1994

[Phase analysis of gated blood pool scintigraphy in traumatic myocardial contusion].

It is not easy to make a diagnosis of myocardial contusion following blunt chest trauma, because most patients have many other concurrent injuries with diverse symptoms. The usefulness of phase analysis of gated blood pool scintigraphy (GBPS) for myocardial contusion following blunt chest trauma was evaluated. Thirty-eight patients who had been strongly suspected of having myocardial contusion from clinical symptoms and electrocardiograms underwent phase analysis of GBPS. The results of phase analysis were compared with those of two-dimensional echocardiography (2-D Echo) and CPK-MB fraction measurement in all patients, with those of 201TlCl myocardial scintigraphy in 35 patients and with those of 99mTc-pyrophosphate scintigraphy in 10 patients. In 29 patients (76.3%), the results of phase analysis matched those of 2-D Echo. Two patients (5.3%) who were judged as positive by 2-D Echo and as negative by phase analysis had only rupture of the chordae. Only one of two other patients who were judged as negative by 2-D Echo and as positive by phase analysis was judged as positive by 201TlCl myocardial scintigraphy. The results of both 2-D Echo and phase analysis were not well correlated with those of CPK-MB fraction measurement and 99mTc pyrophosphate scintigraphy. It is concluded that phase analysis of GBPS, as well as 2-D Echo, is useful for diagnosing myocardial contusion, and that phase analysis is most useful for diagnosing myocardial contusion in patients who cannot be examined by 2-D Echo because of the presence of pneumothorax and/or subcutaneous emphysema in the anterior chest wall.

Adolescent↗
PubMed1994

Outcome of isolated pulmonary contusion in blunt trauma patients.

To determine outcome in young, healthy blunt trauma patients with isolated pulmonary contusion, and to identify factors associated with poor outcome, we reviewed 6012 consecutive adult (aged 16-49) blunt trauma admissions. Ninety-four (7.9%) presented with an isolated pulmonary contusion defined by chest radiograph and Injury Severity Score < 25; they compromise the study group. Poor outcome was defined as death, prolonged hospitalization (> 7 days), or a severe complication (pneumonia, empyema, atelectasis requiring bronchoscopy, or bronchopleural fistula). None of the 94 study patients died. Admission chest radiograph demonstrated no contusion in 34 patients (36%). Fifteen patients (16%) required intubation, but 13 were extubated within 48 hours. Forty-one patients (44%) required insertion of a chest tube, and 20 patients (21%) had a PaO2/FiO2 ratio of < 250 on admission. Post-injury atelectasis (n = 17), pneumothorax (n = 17), effusion (n = 8), pneumonia (n = 2), empyema (n = 1), and Staphylococcal bacteremia (n = 1) complicated hospitalizations. The following clinical factors were identified as predisposing to poor outcome by univariate analysis: 1) Pulmonary contusion on admission chest radiograph (P = 0.035); 2) Three or more rib fractures (P = 0.002); 3) chest tube insertion (P = 0.010) and drainage (P = 0.020); and 4) hypoxia on admission (PO2 < 70 torr [P = .021], PaO2/FiO2 < 250 [P < 0.001]). Only PaO2/FiO2 < 250 on admission was an independent predictor of poor outcome in a multivariate analysis (P = 0.040). Our conclusion was that isolated pulmonary contusion in young, healthy patients is not associated with mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Resuscitation of pulmonary contusion: hypertonic saline is not beneficial.

We postulated that hypertonic solutions could minimize the accumulation of lung water and subsequent respiratory derangements that occur after pulmonary contusion. Anesthetized pigs underwent contusion of the right chest at baseline and then were hemorrhaged (30 cc/kg) over 20 min. They were resuscitated with either 7.5% NaCl (4 cc/kg) or .9% saline (90 cc/kg) for 20 min and observed for 4 h. Gravimetric lung weights and spiral computed tomography scans were used to quantitate lung water. The hemodynamic response to contusion and hemorrhage was similar in both resuscitation groups. Arterial oxygen tension was not significantly altered by the method of resuscitation and remained close to baseline values for the entirety of the experiment. Static compliance measurements were significantly decreased from baseline in both groups following pulmonary contusion. There were no differences in wet to dry lung weights or computed tomography scan injury volume between groups. We conclude that small volume hypertonic saline resuscitation does not reduce the magnitude of lung injury or provide substantial physiologic benefit over isotonic solutions following pulmonary contusion.

Animals↗
PubMed2001

Chemokine antagonist infusion promotes axonal sparing after spinal cord contusion injury in rat.

Spinal cord injury produced by mechanical contusion causes the onset of acute and chronic degradative events. These include blood brain barrier disruption, edema, demyelination, axonal damage and neuronal cell death. Posttraumatic inflammation after spinal cord injury has been implicated in the secondary injury that ultimately leads to neurologic dysfunction. Studies after spinal cord contusion have shown expression of several chemokines early after injury and suggested a role for them in the ordered recruitment of inflammatory cells at the lesion site (McTigue et al. [1998] J. Neurosci. Res. 53:368-376; Lee et al., [2000] Neurochem Int). We have demonstrated previously that infusion of the broad-spectrum chemokine receptor antagonist (vMIPII) in the contused spinal cord initially attenuates leukocyte infiltration, suppresses' gliotic reaction and reduces neuronal damage after injury. These changes are accompanied by increased expression of bcl-2, the endogenous apoptosis inhibitor, and reduced neuronal apoptosis (Ghirnikar et al. [2000] J. Neurosci. Res. 59:63-73). We demonstrate that 2 and 4 weeks of vMIPII infusion in the contusion-injured spinal cord also results in decreased hematogenous infiltration and is accompanied by reduced axonal degeneration in the gray matter. Luxol fast blue and MBP immunoreactivity indicated reduced myelin breakdown in the dorsal and ventral funiculi. Increased neuronal survival in the ventral horns of vMIPII infused cords was seen along with increased bcl-2 staining in them. Immunohistochemical identification of fiber phenotypes showed increased presence of calcitonin gene related peptide, choline acetyl transferase and tyrosine hydroxylase positive fibers as well as increased GAP43 staining in treated cords. These results suggest that sustained reduction in posttraumatic cellular infiltration is beneficial for tissue survival. A preliminary report of this study has been published (Eng et al. [2000] J. Neurochem. 74(Suppl):S67B). In contrast to vMIPII, infusion of MCP-1 (9-76), a N-terminal analog of the MCP-1 chemokine showed only a modest reduction in cellular infiltration at 14 and 21 dpi without significant tissue survival after spinal cord contusion injury. Comparing data on tissue survival obtained with vMIPII and MCP-1 (9-76) further validate the importance of the use of broad-spectrum antagonists in the treatment of spinal cord injury. Controlling the inflammatory reaction and providing a growth permissive environment would enhance regeneration and ultimately lead to neurological recovery after spinal cord injury. J. Neurosci. Res. 64:582-589, 2001. Published 2001 Wiley-Liss, Inc.

Amino Acid Sequence↗
PubMed2001

Degeneration and sprouting of identified descending supraspinal axons after contusive spinal cord injury in the rat.

Contusive spinal cord injury (SCI) results in the formation of a chronic lesion cavity surrounded by a rim of spared fibers. Tissue bridges containing axons extend from the spared rim into the cavity dividing it into chambers. Whether descending axons can grow into these trabeculae or whether fibers within the trabeculae are spared fibers remains unclear. The purposes of the present study were (1) to describe the initial axonal response to contusion injury in an identified axonal population, (2) to determine whether and when sprouts grow in the face of the expanding contusion cavity, and (3) in the long term, to see whether any of these sprouts might contribute to the axonal bundles that have been seen within the chronic contusion lesion cavity. The design of the experiment also allowed us to further characterize the development of the lesion cavity after injury. The corticospinal tract (CST) underwent extensive dieback after contusive SCI, with retraction bulbs present from 1 day to 8 months postinjury. CST sprouting occurred between 3 weeks and 3 months, with penetration of CST axons into the lesion matrix occurring over an even longer time course. Collateralization and penetration of reticulospinal fibers were observed at 3 months and were more extensive at later time points. This suggests that these two descending systems show a delayed regenerative response and do extend axons into the lesion cavity and that the endogenous repair can continue for a very long time after SCI.

Acute Disease↗
PubMed1994

Gadolinium DTPA-enhanced magnetic resonance imaging of cerebral contusions.

The morphological characteristics of cerebral contusions in head trauma patients suggest that an increase in cerebrovascular permeability is responsible for the contusion edema which develops within 1-3 days posttrauma. In the present study, 10 patients with cerebral contusions (mean age, 38 years old; 8 males and 2 females) were examined by gadolinium (Gd)-DTPA enhanced magnetic resonance imaging (MRI) at 1-2 days after trauma. Gd-DTPA (0.3 mmol/kg) was infused intravenously over a period of 30 min. MRIs were taken before, and at 2 and 4 hours after initiation of the Gd-DTPA administration. It was found that contusion edema areas were frequently enhanced by Gd-DTPA at 2 hours. The enhancement diminished at 4 hours. These findings appear to be inconsistent with the results of previously reported similar studies in which enhancement was detected at 6-9 days posttrauma but not during the period earlier than 6 days. This discrepancy may be attributable to the presence of a high blood concentration of Gd-DTPA for a longer period of time and a delay in the time at which MRIs were taken in the present study. The present data indicate that an increased cerebrovascular permeability occurs at as early as 1-2 days posttrauma, and suggest that contusion edema which progresses during the initial 1-3 days may be at least partially vasogenic in nature.

Adolescent↗
PubMed1990

Regional cerebral blood flow in the pig after a localized cerebral contusion treated with barbiturates.

Regional cerebral blood flow determined with microsphere technique in anaesthetized pigs was measured before and after a localized cerebral contusion as well as after treatment with pentobarbital. No overall reduction in intracranial pressure or perfusion pressure was observed. Flow reduction due to pentobarbital was different in different regions with a high percentage change in the highly perfused basal structures and cortical grey matter except in the centre of the contusion where the reduction was half compared to the rest of cortical grey matter. Changes in white matter were less than in cortical grey matter but more pronounced than in the very high flow areas (choroid plexus and pineal gland). The accumulated change was greatest in the damaged region. Contralateral to the contusion, where a significant increase in flow was noticed after the contusion, there was a very low accumulated change in flow. In white subcortical matter underlying the contusion a similar low flow change was observed but this was not accompanied by as large an accumulated change as in grey cortical matter. At each fraction of injected pentobarbital a short-lasting increase in intracranial pressure and a reduction in mean arterial blood pressure was observed. The amplitude and the height of the intracranial pressure change was reduced during the pentobarbital injections.

Animals↗
PubMed1998

Traumatic brain contusions: a clinical role for the kinin antagonist CP-0127.

Focal cerebral contusions can be dynamic and expansive, leading to delayed neurological deterioration. Due to the high mortality associated with such cerebral contusions, our standard practice had evolved into evacuating contusions in patients who had a deterioration in level of consciousness, lesions > 30 cc and CT suggestion of raised ICP. Experimental brain edema studies have implicated kinins in causing 2 degrees brain swelling. CP-0127 (Bradycor), a specific bradykinin antagonist, has been found to reduce cerebral edema in a cold lesion model in rats. In a randomized, single blind pilot study, a 7 day infusion of CP-0127 (3.0 micrograms/kg/min) was compared to placebo in patients with focal cerebral contusions presenting within 24-96 hours of closed head injury with an initial GCS 9-14. The ICP, GCS, and vital signs were monitored hourly. The total lesion burden (TLB) was measured on serial CT scans. There were no differences in age, baseline GCS, TLB, initial ICP, or laboratory findings between the two groups (n = 20). The mean (+/- s.d.) rise in peak ICP from baseline was greater in the placebo group than with CP-0127 (21.9 +/- 4.7 vs 9.5 +/- 2.0, P = 0.018). In addition, the mean reduction in GCS in the placebo group was significantly greater than in the CP-0127 group (4 +/- 1.0 vs 0.6 +/- 0.4, P = 0.002). Significantly raised ICP and clinically significant neurological deterioration occurred in 7/9 patients on placebo (77%) and only in 1 patient (9%; n = 11) on CP-0127, mandating surgery (P = 0.005). There were no adverse drug reactions, significant changes in vital signs or variations in the laboratory values. The cerebral perfusion pressure was adequately maintained in all patients irrespective of therapy. These preliminary results with CP-0127 provide supporting evidence that the kinin-kallikrein system could be involved in cerebral edema. In this study, treatment with CP-0127 appeared to alter the natural history of traumatic brain contusions by preventing the 2 degrees brain swelling. In addition, CP-0127 obviated the need for surgery in the majority of treated patients. CP-0127 could act on the cerebral vasculature to limit dys-autoregulation and brain swelling or on the blood brain barrier to reduce cerebral edema.

Adult↗